FFP infusion

[EmeryRN]

I have been trying to find recent info about this and it's driving me crazy because I'm getting conflicting info r/t infusing plasma. I had an order to infuse 3 units FFP's on an 81 female last night. I infused them over about 30min/unit, and administered IV Lasix after the last unit per MD orders.

My question(s) is:

Was it okay to infuse via 22g IV cath? And over the 30mins?

Keep in mind, she is in her 80's. And I've read that some people don't use pumps, but on the floor (non-ER, for example) we use pumps for basically everything at the hospital I work, and I used a pump like any other time for any other blood product I've administered. I've also read the rationales that for venipunctures, we use butterflies that are 23g or even 25g for lab draws. And for peds, smaller angios are generally used. Generally when we do PRBCs, we prefer 20g as the smallest.

I am worried sick that I dropped the ball by not placing a 20g, mainly because the dayshift RN I gave report to was questioning this and made it seem like I did something wrong (which I hope I didn't and I need your help!). I can't sleep and I'm stressing myself out.

Pt has cirrhosis, hep, and ascites. She tolerated all three units, no s/s of reaction. VSS (bp increased from SBP 100's to 120's), but not elevated, and to be expected).

I'm sorry this ended up long, but I really appreciate some info here. I've been a nurse for about a year and a half and it seems whenever I start to gain some confidence, something happens to throw me off or question myself/stress (but that's a different thread

[arodrz87]

You did fine

[SummitRN, BSN, RN]

These misconceptions about needing a 20ga or larger for blood products lead to practices of larger IVs, more IV start attempts, and sometimes, delay of PRBC administration. There are numerous studies showing that 22ga and 24ga are fine, even at higher rates.

FFP fast is also fine and a regular practice.

[1fastRN]

We generally just dump Ffp in wide open. If anything, run slow initially to monitor for reaction. I always use a 20 or bigger pretty much for anything (ER mentality). I wouldn't worry about it, it infused fine.... don't lose sleep over it.

[applewhitern, BSN, RN]

Our policies are out-dated and I find some of them to be ridiculous. One in particular is that we have to obtain a doctor's order to use a 22 g for PRBC's. Another is to give FFP the same way you would give PRBC's. At other hospitals, we could use a 22 g and we would give FFP fast. I agree with SummitRN, but unfortunately, I have to follow my hospital's policy. You did fine, in my opinion.

[Anna Flaxis, BSN, RN]

We have outdated policies too. Getting them changed would take an act of congress!!!

[1fastRN]

So is there any research or standard for what bore is appropriate for FFP, PRBCS, and blood respectively?

I know 20 is policy at my facility.

What about IV contrast? Do y'all use 20 gauge or bigger above the wrist ?

[HikingEDRN, BSN, RN]

22 gauge is fine. That nurse you gave report to needs to chill.

Couldn't have said it better myself :) Good job OP.

And in my former job in the NICU, all we had were 24 gauges so we always infused prbcs through them.

[ChristineN, BSN, RN]

So is there any research or standard for what bore is appropriate for FFP, PRBCS, and blood respectively?

I know 20 is policy at my facility.

What about IV contrast? Do y'all use 20 gauge or bigger above the wrist ?

IV contrast can be any size any location unless it is a CT Chest for rule out PE. Then it has to be a 20 or bigger AC or higher

[1fastRN]

IV contrast can be any size any location unless it is a CT Chest for rule out PE. Then it has to be a 20 or bigger AC or higher

Even in the hand? The folks in radiology state that it has to be wrist or higher with any contrast because if the line blows the patient could lose their hand. They stress that infiltration of IV contrast in the hand is bad news.

Not sure if this is just policy or EBP.

I love my large bore IVs... but I was trained a lot in trauma so the bigger the better!

[VANurse2010]

I have infused PRBC through a 22 via a pump many times - and the H/H was always successfully raised. Remember, in babies blood is going through a 22 or a 24. You're fine.